Cases of difficulty requiring superior medical experience and skill occur frequently amongst the paupers. For general supervision as well as for the elucidation of particular questions, the Board have proved the practicability of obtaining for the public service the highest medical skill and science. They have availed themselves of more various acquirements than would be found in any standing conseil de salubrité. On questions respecting fever they have availed themselves of the services of the physician of the London Fever Hospital; on questions of vaccination they have consulted the Vaccine Board of London, and the authorities on the same question in Scotland. On questions as to ventilation they have availed themselves of the services of Dr. Arnott; and on the general questions affecting the sanitary condition of the population they have consulted that gentleman and Dr. Kay, and Dr. Southwood Smith, and others who could be found to have given special attention to the subject. When serious epidemics have broken out in particular unions the central Board has dispatched physicians to their aid, or suggested to the guardians that they should have recourse to the services of physicians in the neighbourhoods. The services of Dr. Arnott, Dr. Kay, and Dr. Southwood Smith were thus directed in aid of the medical officers of the eastern districts of the metropolis; and their reports first developed to the public and the legislature the evils which form the subject of the extended inquiry, and that might otherwise have continued without chance of notice, or mitigation or removal, to have depressed the condition of the labouring classes of the population. But the results of such occasional visits appear to prove the necessity and economy of an increase of the permanent local medical service, and to establish a case for the appointment of a superior medical man for a wider district than an ordinary medical officer, for the special aid and supervision of the established medical relief.
It will frequently be found that there is the like need of immediate local inspection of the medical treatment of the destitute that there is of a grade of inspecting surgeons for the military hospitals. It cannot be otherwise than that amidst a numerous body of men there must be much error and neglect in the treatment of the destitute, in the absence of immediate securities against, neglect. The most able of the guardians would confess that if they are not entirely incompetent to supervise medical service, they are at the best but imperfectly qualified for such a task, and the medical officers would act with more satisfaction to themselves from the supervision of officers from whom they might derive aid and confidence.
But besides the medical treatment of the inmates of the workhouses and prisons, there are other cases within most districts which need the preventive service of a superior medical officer for the protection of the public health.
First, in the cases where the poorer classes are assembled in such numbers as to make the assemblages quasi public, and afford facilities for medical inspection, as in schools.
Secondly, also in places of work and in workmen’s lodging-houses. The occasional visits of a district officer, for the prevention of disease would lead to the maintenance of due ventilation, and to the protection of the workpeople on such points as are already specified as injurious to the health, and that arise simply from ignorance, and are not essential to the processes. An examination of such places, if only quarterly, would lead to the most beneficial results.
So far as I have observed the working of the Factory Act, it appears to me that the duties now performed by the sub-inspectors of factories might be more advantageously performed by superior medical officers, of the rank of army surgeons, who are independent of private practice.
I am confirmed in this view by the following evidence of Mr. Baker, surgeon of Leeds, the only factory inspector who has such qualifications:—
“Have you, as a surgeon, whilst visiting the factories as an inspector, had occasion to exercise your professional knowledge?—Frequently; during my service I have turned out great numbers of children with scald-heads, which they were apt to propagate amongst the rest of the children; some with phthisis, whose subsequent death was more than probable; some with scrofulous ulcers; a great many with extreme cases of ophthalmia; probably I may have removed a thousand of these cases altogether. I rarely go to a mill where I do not see a case of scald-head.
“Have you ever had occasion to interpose in respect to ventilation?—Frequently in extreme cases of variable temperature, also in cases of offensive privies, which I find attended by dysenteric affections; and also where there has been offensive water from neglected sewers. I have also endeavoured to enforce personal cleanliness on the children through the instrumentality of overlookers and parents. One practice amongst the children in all kinds of mills is to wear handkerchiefs on the head, by which the neglect of personal cleanliness was concealed. Under these handkerchiefs were most of the cases of scald-head, in a state of filthiness not easily describable. I have assured the operatives that by the Act I had the power to direct measures for the protection of their health as well as labour; and I have established in many places the rule that the children shall come with the faces clean, and the hair combed, and without handkerchiefs whilst at work.”
By such inspection of workpeople in the places of work do you conceive it would be practicable to influence largely the sanitary condition of the labouring population without inspection of the private houses?—Yes; for the ill health which was occasioned by the state of their houses or other places, would of course be visible on such inspection. If they were removed from their places of employment on the presentation of such appearances, the inattention which had occasioned it would be removed too.